MEDICARE: BRUNS CHIROPRACTIC OFFICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4088-012	WI

General Provider Information

NPI Number	:	1386039972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUNS CHIROPRACTIC OFFICE LLC

Provider Business Mailing Address
First Line	:	1429 NORTH AVE
Second Line	:
City	:	SHEBOYGAN
State	:	WI
Zip	:	53083-4760
Country	:	US
Telephone Number	:	920-912-2563
Fax Number	:

Provider Business Practice Location Address
First Line	:	1429 NORTH AVE
Second Line	:
City	:	SHEBOYGAN
State	:	WI
Zip	:	53083-4760
Country	:	US
Telephone Number	:	920-912-2563
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRACTITIONER
Name	:	DR. JOHN K. BRUNS
Credential	:	D.C.
Telephone Number	:	920-912-2563

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	04/01/2015

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